In a recent study conducted for the American Heart Association, Pittsburgh was ranked the fourth least heart-friendly city for women among the United States' 200 largest metropolitan areas.

That's a statistic the staff of the new Women's Heart Center of the Gerald McGinnis Cardiovascular Institute at Allegheny General Hospital in McCandless is determined to change.

"One of our goals is to raise the awareness that heart disease is the No. 1 killer of women," said Dr. Indu Poornima, a cardiologist and director of the heart center.

"Awareness is extremely low. I think they think they're going to die of breast cancer." The truth: Heart disease kills almost twice as many American women as all forms of cancer combined.

Another goal of the heart center, which opened in March, is to teach women the risk factors that lead to heart disease.

The third and most important goal is to get the at-risk women to reduce those factors and therefore reduce their chance of heart disease and heart attack.

"Most of the time, we get to see these people once they've had a heart attack," Dr. Poornima said. "We'd like to target women before ... so we never get to see them having that episode."

The study ranking Pittsburgh so low in heart health was based on 22 factors, including the rate of smoking, obesity, cardiac mortality and regular exercise. Unfortunately, the city's female population scored poorly in a lot of them.

"First and foremost, Pittsburgh has an aging population that has a combination of risk factors -- primarily obesity, hypertension, high cholesterol. So all of these things kind of go together," Dr. Poornima said. "People in general are more sedentary, especially the population that needs most to be active, middle-aged and older people. ... I think for both men and women this is true, but women more so. Obesity in women is extremely high in Pittsburgh."

The good news: "If these people start being more physically active," Dr. Poornima said, "most of these [risk factors] can be reduced."

But why do women need their own heart center?

"Because, like I said, awareness is extremely low," Dr. Poornima said. Not only do many not know the high death rate from heart disease, they are unaware that women have fewer of the typical heart attack symptoms found in men and wait too long to seek help.

"A women goes to her gynecologist and has a Pap smear, a mammogram, maybe her blood pressure checked, but no other tests. ... As for seeing a [primary care physician], either women don't go there or they only go in for acute problems."

Meanwhile, she added, "there are certain unique populations among women that are extremely prone to developing early coronary-artery disease." They include women who have a history of gestational diabetes, high blood pressure during pregnancy, polycystic ovarian disease, and rheumatological diseases such as rheumatoid arthritis and lupus.

"We would like to raise awareness of heart disease among these populations of women ... so we can prevent a heart attack instead of waiting until after it's happened," Dr. Poornima said.

To that end, the center has had an open house, and Dr. Poornima has done a couple of television interviews. Information also is available online at www.aghmcginniscvi.org/services/womens/index.html. The center also hopes to start a newsletter to send to women in nearby north suburban towns and neighborhoods.

Women who come to the center get a complete going-over, starting with blood pressure and standard laboratory blood work measuring blood sugar, cholesterol and lipids.

More specific tests are prescribed on the basis of family history, and since it's housed within the Gerald McGinnis Cardiovascular Institute, the center has on the premises such specialized imaging techniques as nuclear cardiology, cardiac MRIs and echocardiology. Even acupuncture is available for smoking cessation.

"Most important, we identify the risk factors and begin treating them," Dr. Poornima said.

Perhaps equally important, the patient leaves the center with a portfolio of her test results.

"We want her to be in charge of her numbers too, not just the doctor: blood pressure, blood glucose, cholesterol profile. ... All of these are given to her so she knows the risk of heart attack," the heart center director said.

"We estimate the risk: 'Your risk is 5 percent to 10 percent that you'll have a heart attack in 10 years.' I think that makes an impression on the patient. It sets her thinking a little bit more about trying to do something about the risk factors when she knows the numbers of risk of having a heart attack."